Provider Demographics
NPI:1891316220
Name:WEAVER, JAYME LYNN
Entity Type:Individual
Prefix:
First Name:JAYME
Middle Name:LYNN
Last Name:WEAVER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:389 CR 192
Mailing Address - Street 2:
Mailing Address - City:MORAN
Mailing Address - State:TX
Mailing Address - Zip Code:76464
Mailing Address - Country:US
Mailing Address - Phone:501-499-0047
Mailing Address - Fax:
Practice Address - Street 1:389 CR 192
Practice Address - Street 2:
Practice Address - City:MORAN
Practice Address - State:TX
Practice Address - Zip Code:76464
Practice Address - Country:US
Practice Address - Phone:501-499-0047
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-04-27
Last Update Date:2020-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARR072363163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse